Research suggests that training of team coordination skills will be most effective when it incorporates opportunities for interactive practice of those skills in realistic work environments. There is little experimental evidence assessing and comparing the impact of different interactive training approaches with respect to improving the team coordination skills of participants. A multidisciplinary team of researchers at Duke University Medical Center, in collaboration with University of North Carolina Health Care, is developing several simulation approaches toward interactive training of health care team coordination. In addition, Duke University Medical Center and Virtual Heroes, Inc. are developing a 30-interactive networked virtual reality team training tool (3DiTeams). The primary objective of this project is to assess methods of interactive team training in order to design and implement a health care team training program that is (1) cost effective, (2) feasibly implemented in clinical work and professional health care education environments, and (3) has substantial impact on the team coordination skills of trainees. Specific aims include: (1) pilot testing of 3DiTeams as an alternative to traditional interactive team training, (2) experimental comparison of participants' improvement in team knowledge and behaviors following training using 3DiTeams and an alternative interactive team training approach (e.g., high fidelity patient simulation), and (3) evaluation of the resulting experimental data along with realistic cost estimates to design and pilot test an efficient and effective team training program within Duke University Health System. This research has the potential to significantly advance the delivery and distribution of effective team coordination training. Resulting experimental evidence should assist health care organizations in choosing or developing methods of training health care team skills. This research will also provide information needed to support a long term goal of developing health care team training that will be exportable beyond Duke. More importantly, the improvements in health care team training that result from this research are expected to have a broader impact on public health through the reduction of health care adverse events and enhancement of patient safety. [unreadable] [unreadable] [unreadable]